Thursday 25 August 2016 10.15 EDT
First published on Thursday 25 August 2016 02.55 EDT

The death toll from the devastating pre-dawn earthquake that struck central Italy on Wednesday has been raised to 241, after rescue teams using sniffer dogs, bulldozers and their bare hands worked through the night in a desperate search for survivors.

At least 368 more people were injured, the national civil protection agency said in Rome, and an unknown number remained trapped in the rubble of collapsed and damaged buildings in the cluster of ancient hilltop towns and villages, some almost entirely razed by the 6.2-magnitude quake.

A powerful aftershock of 4.3 was reported in Amatrice on Thursday afternoon, prompting rescue workers to retreat from damaged buildings and sending a huge dust cloud into the air.

One of the youngest victims was an 18-month-old girl whose mother survived the 2009 quake in L’Aquila, a few miles south of the epicentre of Wednesday’s 3.36am tremor.

The quake flattened houses, buckled roads and buried residents under mounds of debris in and around Amatrice, Accumoli and Arquata and Pescara del Tronto.

“The town just isn’t here any more,” said Sergio Pirozzi, the mayor of Amatrice, voted one of Italy’s most beautiful historic towns last year. He feared 200 people, including many of his friends, could have died in the town and up to 40 were missing. “Our heart is broken, but will be resurrected,” he told RAI News.

Italy earthquake: death toll rises to 159 as search for survivors continues – live

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Lorenzo Boti, 59, a firefighter who arrived from Rome on Wednesday evening, said the situation was still very dangerous. He estimated around 15 survivors had been rescued overnight, including several children: “There are no words when that happens. It’s an emotional feeling inside; it makes you feel alive.”

But, Boti added, “I don’t like to count the number of dead bodies. There are so many children.” His team had recovered the body of a three or four-year-old child this morning, he said, and there would certainly be more to come: “Many of these buildings are still very unstable.”

To muted cheers and applause, rescuers working in the darkness with emergency lighting had earlier pulled a 10-year-old girl alive from the rubble in Pescara del Tronto late on Wednesday night, nearly 20 hours after the quake struck.

Other children, however, were not so lucky: among those who died in nearby Accumoli were a family of four, including two boys aged eight months and nine years.

Cristobal Rodriguez, from a Spanish emergency rescue NGO, arrived from Málaga with his dog Lula at 10pm on Wednesday after travelling for eight hours. His group headed first to Accumoli, but then left for harder-hit Amatrice.

“Only 20% of that town was affected. Here, it’s much worse,” he said. “Still, we are hopeful of finding more survivors.” His colleague, Juan Manuel La Cueva, with his dog Blackie, said firefighters from Málaga were often among the first to be called: “We have the best dogs.”

A veteran of numerous international disasters, La Cuava said this one was “Hard. It’s tragic. For Europe, this is very dramatic. We were hoping to find there were fewer victims. It’s truly tragic.”

But he was convinced more survivors would be found. Dogs were useful for the first three days, he said, as few victims can survive longer than that without water. “We will find them,” he said. “We’ll sleep when we’re back in Spain.”

Italy’s prime minister, Matteo Renzi, warned after visiting the remote area, which straddles the regions of Umbria, Marche and Lazio about 90 miles east of Rome, that the toll from the quake – felt more than 135 miles away, in Bologna to the north and Naples to the south – was likely to rise.

“Right now we feel terrible pain,” Renzi said. “Italy is a family that has been hit and struck, but we are not going to be stopped. From tomorrow, and in the next few months, we’ll work on reconstruction. But now is a time to pray and shed tears; a moment for respect and pain for all Italians for this huge shock.”

Hastily erected tent cities and kitchens outside the ruined towns catered to some of the more than 2,000 people unable to return home because of the risk from aftershocks. The mountainous area, just north of L’Aquila, which was hit by a 2009 earthquake that left 300 dead, is particularly popular with holidaymakers escaping the summer heat of Rome.

“Tonight will be our first nightmare night,” said Alessandro Gabrielli as he prepared to spend the night in one of the many emergency tents, each housing 12 homeless quake victims. “Last night, I woke up with a sound that sounded like a bomb.”

The influx of visitors makes it hard for rescuers to know exactly how many people were staying in holiday homes and hotels. More than 70 were initially thought to be inside the Hotel Roma in Amatrice when it collapsed, but the number was later lowered to 35, many of whom survived. Five bodies were pulled from the rubble and 10 guests were still missing.

A steady stream of trucks brought tonnes of twisted metal, rock and cement down the hill and on to the main road on Wednesday, passed in the other direction by cranes, bulldozers and rescue teams from the army, Alpine guides, carabinieri, firefighters, Red Cross and volunteers. Many small, remote hamlets had to wait several hours before they were reached.

People keep warm under blankets after the earthquake in Amatrice. Photograph: Stefano Rellandini/Reuters

Italy’s earthquake institute, INGV, said the focus of the quake was near Accumoli and Amatrice and was relatively shallow, at about 2.5 miles underground. Italy sits on two fault lines, making it one of Europe’s most seismically active countries.

“The Apennine mountains in central Italy have the highest seismic hazard in western Europe and earthquakes of this magnitude are common,” said Richard Walters, a lecturer in Earth sciences at Durham University.

The country’s most deadly earthquake since the start of the 20th century came in 1908, when a major tremor followed by a tsunami killed an estimated 80,000 people in Reggio Calabria and Sicily.